as long as you customize each visit.”Customizing each note with each en-counter is a key to avoiding fraud charges,adds Deborah Robb, director, physicianServices, at Trust HCS, which providescoding consulting and outsourcing ser-vices. Robb agrees that increases in re-imbursement have been driven largelyby improved documentation offered byEHRs.

But she cautions against the practiceof copy and pasting notes, lamenting thefact that some providers are even encour-aged to use the practice as part of theirhospital documentation. “How can youjustify medical necessity when a note isidentical to yesterday’s?” she asks. “Everynote should stand on its own.”

Cloned notesThe problem of cloned notes typicallysurfaces more in the hospital settingthan a clinic setting, Robb says. And eventhough coders may assign the codes,based on the documentation providedby the physician, they can’t always tell ifa note is virtually identical to its prede-cessor. But pulling forward certain ele-ments is important, she adds. “Hospitalsneed to develop policies about what arethe acceptable parameters” for copy-ing past notes, she advises, particularly

“We want tomake sure thereis no roguecoder.”—Money Atwal

when it comes to ancillary services, labvalues and radiology results. “You shouldnot have to rewrite what the lab did. Thatis valuable to pull forward. At the sametime, compliance departments shouldsay what is acceptable.”For many, the very complexity of

HHS FIRES A SHOT

Following is the full text of the letter HHS Secretary KathleenSebelius and Attorney general Eric Holder sent to five hospitalassociations warning them against using electronic health re-cords to “game” the billing system. The letter was addressedto the American Hospital Association, Federation of AmericanHospitals, Association of Academic Health centers, Associa-tion of American Medical colleges and national Association ofpublic Hospitals and Health Systems:“As leaders in the health care system, our nation’s hospitalshave been at the forefront of adopting electronic health re-cords for use in coordinating care, improving quality, reducingpaperwork, and eliminating duplicative tests. over 55 percentof hospitals have already qualified for incentive paymentsauthorized by congress to encourage health care providers toadopt and meaningfully use this technology. Used appropriate-ly, electronic health records have the potential to save moneyand save lives.

“However, there are troubling indications that some providers are using this technology to game the system, possibly to
obtain payments to which they are not entitled. False documentation of care is not just bad patient care; it’s illegal. These
indications include potential ‘cloning’ of medical records in
order to inflate what providers get paid. There are also reports
that some hospitals may be using electronic health records
to facilitate ‘upcoding’ of the intensity of care or severity of
patients’ condition as a means to profit with no commensurate
improvement in the quality of care.

A patient’s care information must be verified individually toensure accuracy; it cannot be cut and pasted from a differentrecord of the patient, which risks medical errors as well asoverpayments. The centers for Medicare and Medicaid Ser-vices is specifically reviewing billing through audits to identifyand prevent improperly billing. Additionally, cMS is initiatingmore extensive medical reviews to ensure that providers arecoding evaluation and management services accurately. Thisincludes comparative billing reports that identify outlier facili-ties. cMS has the authority to address inappropriate increasesin coding intensity in its payment rules, and cMS will considerfuture payment reductions as warranted.